A Study Comparing Modified Alvarado Score and Tzanaki’s Score for Diagnosing Acute Appendicitis

INTRODUCTION: Acute appendicitis is one of the most common cause of Abdominal surgical emergencies. It is associated with high morbidity and occasional mortality related to failure of making an early diagnosis. Acute appendicitis is still a clinical diagnosis. Abdominal pain being the most common symptom. In the classic presentation, the patient describes the pain as beginning in the periumbilical or epigastric region and then migrating to right iliac fossa. This is associated with fever, anorexia, nausea, and vomiting. This “classic” symptomatology only occurs in 50-60% of cases making the diagnosis difficult. A negative appendectomy rate of 20-40% has been reported in the literature and many surgeons advocate early surgical intervention for the treatment of acute appendicitis to avoid perforation, accepting a high appendectomy rate. Removing normal appendix is an economic burden on both patients and health resources. Misdiagnosis and delay in surgery can lead to complications like perforation and finally peritonitis. Many scoring systems for the diagnosis of acute appendicitis have been tried. The Modified Alvarado Score is an easy, simple and cheap diagnostic tool for supporting the diagnosis of acute appendicitis. Tzanakis score is another scoring is a combination of clinical evaluation, inflammatory markers and ultrasound. Our study compares the efficacy of Alvarado score and Tzanakis score in diagnosing acute appendicitis. AIM OF THE STUDY: To compare the efficacy of Modified Alvarado Score and Tzanakis Score in Diagnosing Acute Appendicitis. MATERIALS AND METHODS: This study includes 100 patients admitted in the Department of General Surgery, Government Royapettah Hospital during the period of March 2018 to September 2017 with suspicion of acute appendicitis. Both Modified Alvarado Score and Zanakis score are done for all the patients. Patients underwent emergency open appendicectomy and final diagnosis was confirmed by Histopathothogical examination. Data was be analyzed to compare the efficacy of both scoring systems in diagnosing Acute appendicitis. ANALYSIS OF THE STUDY: The most common position of appendix intraoperatively was retrocaecal. • There was a slight male preponderance with 60 patients being males and 40 patients being females (Male : Female = 3:2). • The mean age of patients was 22.93 years with a standard deviation of 6.86 years. • 83% of patients has histologicaly proven appendicitis. • Overall negative appendicectomy rate was 17%. • The sensitivity & specificity of Modified Alvarado Score was 95.81% & 94.11% with a positive predictive value of 98.75% & negative predictive value of 80%. The positive likely hood ratio was 16.18 and negative likelihood ratio was 0.05. • The sensitivity and specificity of Tzanakis score was 97.59% and 94.11% respectively with a positive predictive value of 98.78% and negative predictive value of 88.88%. The positive likely hood ratio was 16.59 and negative likelihood ratio was 0.03. • The diagnostic accuracy of Alvarado score was 95% and that of Tzanakis score was 97%. • Thus our study shows that Tzanakis scoring has improved sensitivity and Diagnostic accuracy, though specificity remains the same. CONCLUSION: This study shows that Tzanakis scoring system can be used as an effective modality in the establishment of accuracy in diagnosis of acute appendicitis. There is increased sensitivity and diagnostic accuracy in Tzanakis scoring when compared to modified Alvarado score